Chocolate

• Background
• Related terms
• Evidence
• Dosing
• Safety
• Methodology
• Selected references

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Chocolate

Background

Cocoa and chocolate are derived from the cacao bean ( Theobroma cacao ). Cacao is native to South America and has been grown in the tropics for at least 3,000 years. Today, the African country Ivory Coast is the largest supplier of raw cocoa.

Cocoa products have been considered delicacies by many cultures. Cocoa products have recently been recognized as a significant source of a number of compounds, such as flavonoids, that may have valuable health benefits. For this reason, and because it is so popular, chocolate is the focus of intense research.

Chocolate has been studied to investigate its effectiveness in the treatment of a variety of conditions, including heart disease, skin conditions, and constipation. However, there is a lack of studies to support the use of chocolate to treat any conditions in humans.

Related terms

Anandamide, black chocolate (BC), Butyrum cacao , cacahuatl (Nahuatl), cacao (Brazilian Portuguese, English, Spanish), cacao bean husk extract, cacao tree, cacaoboom (Dutch), cacaoeiro (Brazilian Portuguese), cacaoyer (French), cacaueiro (Brazilian Portuguese), caffeine, carboxylic acids, catechin, CBC, CBH, chicolatl (Nahuatl), chocol (Mayan), chocolate flavonoids, chocolate milk, chocolate tree, cocoa bean, cocoa bran, cocoa butter, cocoa husk, cocoa oil, cocoa powder, cocoa tree, CocoaVia®, dark chocolate, Dutch chocolate, epicatechin, FCMC, fiber, flavan-3-ols, flavanols, flavonoids, granos de cacao (Spanish), harilik kakaopuu (Estonian), hot chocolate, inulin, isomalt, kakao (Danish), Kakao (German), kakaó(fa) (Hungarian), Kakaobaum (German), Kakaopflanze (German), kakaotræ (Danish), kakaowiec (Polish), kakav (Slovenian), kawkaw (Mayan), ke ke (Chinese), lipids, methylxanthine alkaloids, methylxanthines, milk chocolate, N-linoleoylethanolamine, N-oleolethanolamine, oleic acid, oligofructose, palmitic acid, phenylethylamine, phytochemicals, phytosterols, polyphenols, procyanidin oligomers, procyanidins, purine alkaloids, saturated fatty acids, sorbitol, stearic acid, Sterculiaceae (family), stimulant drug, sucrose, Theobroma cacao L., theobromine, white chocolate, xocoatl (Mayan, Nahuatl), xocolatl (Mayan, Nahuatl).

NOTE : This monograph covers Theobroma cacao , cacao, cocoa products, and chocolate.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne, alopecia (hair loss), Alzheimer's disease, antibacterial, antidepressant, anti-inflammatory, antimutagenic (inhibits mutations, or changes, in DNA), antiseptic, aphrodisiac (increases sexual desire), asthma, bronchitis, cancer, childbirth (labor induction), cognitive function, cough, dementia, dental caries (cavities), diabetes, diarrhea, diuretic (increases urine flow), eating disorders, elevation of energy, emmenagogue (menstrual flow stimulant), exercise capacity, exercise recovery, expectorant (encourages coughing up of mucus), eye problems, fatigue, fever, food flavoring, food uses, fragrance, immunomodulator (affects the immune system), inflammation, kidney and bladder disorders, lactose intolerance, liver conditions, malaria, migraine, mood enhancement, nephrosis (kidney disease), neurodegenerative diseases (nervous tissue disease), osteoporosis prevention, pain, parasiticide (parasite-killing substance), Parkinson's disease, pregnancy, relaxation/stress/anxiety, rheumatism, sensory stimulation, snakebite, stimulant, stroke, tonic.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

For use as an antioxidant, one serving of the flavanol-rich drink CocoaVia® taken by mouth has been used.

For cardiovascular disease, one flavanol-rich chocolate bar and cocoa drink taken by mouth once daily for six weeks has been used. One CocoaVia® drink for two days has also been used.

For high cholesterol, one CocoaVia® Crunch snack bar daily for six weeks has been used. One high-flavanol cocoa drink daily for six weeks has also been used.

For high blood pressure , 100g of dark chocolate taken by mouth daily for 15 days has been used.

For skin conditions, a high-flavanol cocoa powder dissolved in hot water taken by mouth daily for 12 weeks has been used.

For wound healing, cocoa butter rubbed on a burn scar for 30 minutes twice a week for five weeks has been used.

As an insect repellent, cocoa oil applied to the skin has been used.

Children (under 18 years old)

For constipation, a supplement containing 4g of cocoa husk dissolved in 200mL of milk taken by mouth twice daily for four weeks in children 3-6 years old has been used. A larger dose of the same supplement, containing 8g of cocoa husk dissolved in 200mL of milk, taken by mouth twice daily for four weeks in children 7-10 years old has been used.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid with known allergy or hypersensitivity to chocolate, cocoa, any of its components (including caffeine), or members of the Sterculiaceae family. Migraine headaches and eczema have been reported.

Side Effects and Warnings

General: Some side effects and warnings are based on the relatively high levels of caffeine in chocolate.

Use with caution in patients with addictive tendencies, anemia, cardiovascular disease, endocrine disorders, gastrointestinal disorders, nervous disorders, respiratory disorders, and skin disorders. Use with caution in patients prone to migraine headaches or kidney stones. Use with caution in patients who are overweight or obese and in those trying to become pregnant.

Use with caution in patients using agents that affect the cardiovascular system, antimicrobials, ergot derivatives, painkillers, birth control pills, and stimulants.

Use cautiously in children, due to the risk of developing habits that could lead to obesity and poor health.

Chocolate may raise blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Chocolate may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Chocolate may increase blood pressure. Caution is advised in patients with high blood pressure and in those taking drugs, herbs, or supplements that affect blood pressure.

Pregnancy and Breastfeeding

Use with caution and avoid excessive doses of chocolate during pregnancy and breastfeeding, due to the relatively high level of caffeine in chocolate. Chocolate also contains two compounds that may cause birth defects.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

1. Allan JL, Johnston M, Campbell N. Unintentional eating. What determines goal-incongruent chocolate consumption? Appetite 2010;54(2):422-5.
2. Almoosawi S, Fyfe L, Ho C, et al. The effect of polyphenol-rich dark chocolate on fasting capillary whole blood glucose, total cholesterol, blood pressure and glucocorticoids in healthy overweight and obese subjects. Br J Nutr 2010;103(6):842-50.
3. Chapelot D, Payen F. Comparison of the effects of a liquid yogurt and chocolate bars on satiety: a multidimensional approach. Br J Nutr 2010;103(5):760-7.
4. Corti R, Perdrix J, Flammer AJ, et al. Dark or white chocolate? Cocoa and cardiovascular health. Rev Med Suisse 2010;6(239):499-500, 502-4.
5. Desch S, Kobler D, Schmidt J, et al. Low vs. higher-dose dark chocolate and blood pressure in cardiovascular high-risk patients. Am J Hypertens 2010;23(6):694-700.
6. Grassi D, Desideri G, Ferri C. Blood pressure and cardiovascular risk: what about cocoa and chocolate? Arch Biochem Biophys 2010;501(1):112-5.
7. Milliron T, Kelsberg G, St Anna L. Clinical inquiries. Does chocolate have cardiovascular benefits? J Fam Pract 2010;59(6):351-2.
8. Miracle VA. Chocolate: the health food. Dimens Crit Care Nurs 2010;29(2):108-9.
9. Mostofsky E, Levitan EB, Wolk A, et al. Chocolate intake and incidence of heart failure: a population-based prospective study of middle-aged and elderly women. Circ Heart Fail 2010;3(5):612-6.
10. Ried K, Sullivan T, Fakler P, et al. Does chocolate reduce blood pressure? A meta-analysis. BMC Med 2010;8:39.
11. Rose N, Koperski S, Golomb BA. Mood food: chocolate and depressive symptoms in a cross-sectional analysis. Arch Intern Med 2010;170(8):699-703.
12. Rusconi M, Conti A. Theobroma cacao L., the Food of the Gods: a scientific approach beyond myths and claims. Pharmacol Res 2010;61(1):5-13.
13. Saftlas AF, Triche EW, Beydoun H, et al. Does chocolate intake during pregnancy reduce the risks of preeclampsia and gestational hypertension? Ann Epidemiol 2010;20(8):584-91.
14. Turner SA, Luszczynska A, Warner L, et al. Emotional and uncontrolled eating styles and chocolate chip cookie consumption. A controlled trial of the effects of positive mood enhancement. Appetite 2010;54(1):143-9.
15. Vermeer WM, Bruins B, Steenhuis IH. Two pack king size chocolate bars. Can we manage our consumption? Appetite 2010;54(2):414-7.

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